DENTISTRY TO-DAY

Otago Daily Times, Issue 26078, 15 February 1946, Page 6

DENTISTRY TO-DAY

VALUE OF RESEARCH REMARKABLE ADVANCES By Dr John Hadin Barr (University of Otago) II No longer does a visit to the dentist justify the tradition wthich associates the experience with excruciating practices adopted in the name of saving teeth. No more do patients have to be virtually asphyxiated in order to have their teeth removed. Their trealmeht need not be based haphazardly on wthat may happen to be visible to the eye. Nor will dentists again be manoeuvred into the position of having to accept and use products the composition of which remains the secret of manufacturers, reputable or otherwise. These are features of the past, for twentieth century scientific achievement Bias wrought vast changes. To-day we find that the dentist may have at his disposal the opportunity for a logical and considerate approach to the problems of his patients. Build-' ing on the foundation of specialised university education and backed by the material facilities of an industrialised age, he can recognise with certainty the nature and extent of the dental conditions with which he is commonly confronted in his practice; and it follows that he can advise and plan treatment with an unprecedented degree of confidence in the soundness of his judgment. No less is the success of this treatment enhanced by the techniques developed for his use and by the modern tools and products which he will employ in treatment. Technical Progress Research in dentistry has been in two fairly well-defined directions. On the one hand, there has been the search for the causes of dental diseases and the means by which they may be prevented or minimised. Concurrently there has also been research mostly of a technical nature, the aim of which has been, broadly speaking, to improve the methods of treatment for dental disease once it has become established in the mouth. This article proposes to examine the results which have followed research of the latter type. In a subsequent article, the questions confronting those workers pursuing more fundamental dental research will be discussed, and notice taken of conclusions to which they have been able to come together with their application in preventive denistry. The modern practice of dentistry is a far cry from that of a century ago, by which time dentistry had emerged as a profession. The striking progress towards perfection of methods of treatment is the result of technical advances which have more than kept pace with our growing knowledge of the nature of dental diseases. These advances, strangely enough, have arisen partly through the spontaneous experimentation and ingenuity of individual practising dentists, _ partly through the more deliberate interest in technical improvements shown by the manufacturers of dental supplies, but seldom through any conscious move on the part of the dental profession as such. Not until quite recently —within the last decade—has organised dentistry come to assume any responsibility for reseach on the technical side. To-day we find the profession itself initiating and sponsoring research of this kind, assuming a direction over current technical research wherever it goes on, and functioning especially to set up clearly defined standards for its specialised products. New Frontiers The practitioner of to-day has, through modern facilities and materials', an opportunity only dreamed of by his predecessors in the control and treatment of dental diseases. For, if he chooses to take full advantage of his opportunity, the dentist can now assure that very nearly every young patient placed in his care will come through the critical years of adolescence and continue well into middle age with a complete set of natural, vital, healthy teeth, favouring good health, good mastication of food, clear speech and attractive appearance. That is surely a creditable achievement for technical research in dentistry. And it does not leave the patient there; for if and when the teeth no longer conform to requirements for good health, research has further assured that they can be safely removed with the minimum' of personal discomfort, and replaced by artificial substitutes of surprising efficiency. This technical development has been a process so gradual that it can best be recognised in retrospect; some notable developments stand out as milestones, and not all of them as milestones on the road to real progress. Many developments have not merited conspicuous mention either in the lay press or in dental literature; but collectively all have contributed to significant change in methods, procedures and materials Involved in practice. New techniques have supplanted old methods, new and improved materials and utilities have replaced older things, and facts have replaced guesswork in the dental operating room and laboratory, all because of research. / Guesswork Gone Foremost in the elimination of guesswork from examination and diagnosis of conditions present in the mouth is undoubtedly the application of the X-ray to dentistry. Originally appreciated for its usefulness in assisting to discover those chronic inflammatory conditions familiar, as abscesses and pyorrhoea, it is now becoming recog-, nised as even more useful in detecting decay cavities between the teeth. Its amazing efficiency in this respect has been amply proved and it is safe to predict that , X-ray examination for cavities must become routine at least once a year for most patients. It reveals with uncanny certainty what so often the eye can neither see nor the dentist’s probe feel—decay cavities, from their earliest stages, located between .the teeth. No longer need cavities be permitted to extend in size, unrecognised until the existence and health of the tooth is threatened. Irrespective of the system, public or private, under which treatment is given, few patients and no dentist can afford to overlook the importance of this development in dentistry. Advanced Methods Dentist, and doubtless their patients, too, dream of some substance or material which could be readily moulded into decay cavities in teeth and which would there retain its form, arrest the decay process, and match the tooth colour. But while it is still necessary to excavate laboriously or drill the cavities in preparation for filling with materials far from ideal, the iact remains that the latter treatment has the merit of effectiveness, and much more so than was the case years ago. Whatever regrets we may feel for the almost complete disappearance of the hammered gold foil filling so familiar to patients in times gone by—it was a wonderful filling—modern dentistry is well provided with alternatives. So greatly have techniques and materials been improved that no vital tooth need be sacrificed for want of applied technical research. Already notable developments within this present century are the introduction and precision development of the now well-known “gold inlay,” the prescription— bj* the profession—of standards to which products it uses must conform in manufacture and working properties, and the wide use of new local anaesthetics for the elimination of pain in preparing cavities for filling, to quote but a few which the layman can appreciate. And this takes no account of the progressive development of earlier procedures which to-day>. show faint resemblance to their original form. Recent advance' in other directions is no less impressive. It is but 30 years since the introduction of the gas and oxygen anaesthesia which replaced virtual asphyxiation by what is more comparable with deep natural sleep. Specialised precision-made instruments make possible modern surgery in the mouth. Metallurgists have produced special alloys for orthodontic appliances designed to correct malformations in the mouth, and for use in the exceedingly ingenious devices now employed in replacing odd missing teeth.

Recent developments in materials for artificial dentures and the life-like porcelains for the new teeth they carry are already well-known for their contribution to personality and comfort. And to enable the dentist to take full advantage of new techniques in treatment, research has revolutionised the customary itfims of dental equipment, though in all truth there is still in this field fordiuman ingenuity to express itself. Modern dentistry is still faced.with the treatment of disease; but it is able, given the chance, to control diseases of the mouth in conformity with the interests of health. Its success is nc mean achievement.